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Cirrhosis and Its Complications: Prognosis and Clinical Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 20 May 2026 | Viewed by 6039

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Dr. Ana-Maria Singeap

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1. Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania 2. Institute of Gastroenterology and Hepatology, "St. Spiridon" University Hospital, 700111 Iasi, Romania
Interests: metabolic dysfunction-associated steatotic liver disease; cirrhosis; liver transplantation; gastrointestinal bleeding
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Special Issue Information

Dear Colleagues,

Cirrhosis remains a major global health burden, with its complications significantly impacting morbidity, mortality, and healthcare systems. This Special Issue will provide a comprehensive overview of the latest advances in prognosis, risk stratification, and clinical management in cirrhosis and its complications, including portal hypertension, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, acute-on-chronic liver failure (ACLF), and hepatocellular carcinoma. A concomitant focus will be placed on the liver transplantation setting, including criteria, patient assessments, and the refinement of follow-up strategies. In addition, we welcome contributions discussing the impact of cirrhosis on patients’ quality of life, exploring how chronic symptoms, comorbidities, and treatment influence overall well-being.

We invite the submission of original research articles, reviews, and clinical perspectives addressing emerging diagnostic tools, biomarkers, novel therapeutic strategies, and multidisciplinary approaches to optimizing patient outcomes. In particular, papers should address challenges faced in individualized treatment, the prevention of disease progression, and the management of comorbidities.

This Special Issue will serve as a valuable resource for hepatologists and all healthcare professionals involved in the care of patients with cirrhosis. By bringing together cutting-edge research articles and expert insights, we aim to advance clinical practice and improve patient prognoses.

Dr. Ana-Maria Singeap
Guest Editor

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Keywords

cirrhosis
complications
spontaneous bacterial peritonitis
portal hypertension
ascites
hepatorenal syndrome
hepatic encephalopathy
liver transplantation
acute-on-chronic liver failure
hepatocellular carcinoma
quality of life
prognosis
clinical management

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Published Papers (5 papers)

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Research

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22 pages, 1407 KB

Open AccessArticle

Factors Associated with Early Rebleeding After Endoscopic Variceal Ligation in Cirrhotic Patients: A Retrospective Cohort Study

by Simona Juncu, Ana-Maria Sîngeap, Horia Minea, Andreea Lungu, Alexandru Sebastian Cotleț, Ana-Maria Buzuleac, Raluca Avram, Cristina Muzica, Laura Huiban, Irina Gîrleanu, Alina Ecaterina Jucan, Georgiana-Emmanuela Gîlcă-Blanariu, Andrei Ciobica, Alin Ciobica, Anca Trifan and Camelia Cojocariu

J. Clin. Med. 2026, 15(6), 2372; https://doi.org/10.3390/jcm15062372 - 20 Mar 2026

Viewed by 360

Abstract

Background: Early rebleeding after endoscopic variceal ligation (EVL) represents a serious complication in patients with cirrhosis and is associated with poor short-term outcomes. This study aimed to identify independent predictors of early rebleeding after EVL, with a particular focus on distinguishing factors associated with variceal rebleeding from those related to post-banding ulcer (PBU) bleeding, and to assess predictors of six-week mortality. Methods: We conducted a retrospective cohort study including 217 cirrhotic patients who underwent first emergency EVL for an index episode of esophageal variceal bleeding at a tertiary referral center. Early rebleeding was defined as recurrent upper gastrointestinal bleeding occurring between days 6 and 42 after the index EVL. Results: Early rebleeding occurred in 38/217 patients (17.5%): 27/38 (71.1%) variceal rebleeding and 11/38 (28.9%) PBU rebleeding. In multivariable logistic regression analysis, lower hemoglobin (OR = 0.19, 95% CI: 0.067–0.539, p = 0.002) and a higher albumin–bilirubin (ALBI) grade (OR = 24.94, 95% CI: 1.134–548.342, p = 0.041) were independently associated with increased odds of early variceal rebleeding, whereas a higher number of bands applied during index EVL (OR = 0.52, 95% CI: 0.302–0.896, p = 0.019) was independently associated with reduced odds of rebleeding, with excellent model discrimination (area under the curve [AUC] 0.981; 95% CI: 0.959–1.000). For PBU rebleeding, lower fibrinogen level was the only independent predictor (OR = 0.957, 95% CI: 0.916–1.000, p = 0.047), with strong discriminative performance (AUC 0.945; 95% CI: 0.909–0.982). Model for End-Stage Liver Disease (MELD) score, serum albumin, platelet count, and PBU rebleeding independently predicted six-week mortality. Conclusions: Markers of liver function, along with endoscopic parameters, predict early rebleeding after EVL, emphasizing the importance of the complete assessment of cirrhotic patients for refined risk stratification and tailored post-EVL management. Full article

(This article belongs to the Special Issue Cirrhosis and Its Complications: Prognosis and Clinical Management)

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41 pages, 2397 KB

Open AccessArticle

A Retrospective Analysis of Hepatic Disease Burden and Progression in a Hospital-Based Romanian Cohort Using Integrated Cross-Sectional and Longitudinal Data (2019–2023)

by Alina Dumitrache (Păunescu), Nicoleta Anca Șuțan, Diana Ionela Popescu (Stegarus), Liliana Cristina Soare, Maria Cristina Ponepal, Cristina Florina Mihăescu, Maria Daniela Bondoc, Muhammed Atamanalp, Ana Cătălina Țânțu, Cătălina Gabriela Pisoschi, Ileana Monica Baniță and Monica Marilena Țânțu

J. Clin. Med. 2026, 15(2), 454; https://doi.org/10.3390/jcm15020454 - 7 Jan 2026

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Abstract

Objective: To analyze demographic traits, clinical complications, and healthcare use in patients with chronic liver disease across major etiologies in a large Romanian cohort. Methods: A retrospective study (2019–2023) of 2359 patients with chronic hepatitis C (CHC), hepatitis associated with alcohol (ALH), cirrhosis associated with alcohol (ALC), or non-alcoholic cirrhosis (NALC). Data on demographics, clinical outcomes, and hospitalizations were analyzed using descriptive statistics, regression modeling, and clustering in IBM SPSS 27.0.1. Results: CHC patients were oldest (mean 67.5 ± 12.3 years), while ALH patients were youngest (56.0 ± 11.0 years). CHC prevalence increased with age (10.0% in ≤30-year-olds to 87.1% in ≥81-year-olds; γ = 0.535, p < 0.001). Females comprised 60–70% of CHC cases, males > 85% of ALH and >78% of ALC. Mean hospitalization duration decreased from 13.80 days (2019) to 9.10 days (2023), yet cirrhotic patients had the longest stays (NALC: 16.37 ± 14.34; ALC: 17.66 ± 12.96) versus CHC (10.38 ± 10.14). Etiology was the strongest predictor of hospitalization length. Portal hypertension (PH) was the most common complication (54.3%), with males bearing more severe hepatic complications (ascites—38.3%; PH—66.8%). Conclusions: Hospital-based Romanian cohort analysis revealed that patient presentation and outcomes are fundamentally shaped by the interplay of etiology, sex, and age. We found a distinct female predominance in CHC, a pronounced male predominance in alcohol-related diseases, and evolving trends in non-alcoholic cirrhosis. These determinants dictate specific epidemiological patterns, hospitalization burdens, and complication risks, underscoring the critical need for a paradigm shift toward personalized, etiology-driven, and sex-tailored clinical management. Full article

(This article belongs to the Special Issue Cirrhosis and Its Complications: Prognosis and Clinical Management)

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10 pages, 473 KB

Open AccessArticle

Acute Variceal Bleeding During the SARS-CoV-2 Pandemic: A National Multicenter Observational Study

by Gabriel Allo, Stefanie Quickert, Karsten Große, Sidar Baysal, Dirk Nierhoff, Christoph Neumann-Haefelin, Christoph Schramm, Tony Bruns, Philipp Alexander Reuken and Martin Bürger

J. Clin. Med. 2025, 14(17), 6166; https://doi.org/10.3390/jcm14176166 - 31 Aug 2025

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Abstract

Background: The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about its negative impact on patients with chronic liver diseases by contributing to hepatic decompensations such as acute variceal bleeding (AVB). This study aimed to evaluate the impact of the COVID-19 pandemic on clinical outcomes in cirrhotic patients with AVB in Germany. Methods: This retrospective national multicenter study compared patients with cirrhosis and AVB treated at four tertiary care centers in Germany before (2016–2020) and during the pandemic (2020–2022). The primary endpoint was 6-week mortality, and secondary outcomes included infections, transfusion requirement and rebleeding. Results: The baseline characteristics of the 247 patients were largely comparable between the two groups, however metabolic dysfunction-associated steatotic liver disease was more prevalent during the pandemic compared to the pre-pandemic period (12.5% vs. 4.8%, p = 0.048). Only one patient tested positive for SARS-CoV-2. Six-week mortality (32.2% vs. 30.1%; p = 0.767) and rebleeding rates (22.8% vs. 22.3%; p = 1.000) did not differ significantly between groups. Interestingly, intubation rates, length of stay on the intensive care unit, post AVB infection rates and types of infection were also comparable (all p > 0.05), while transjugular intrahepatic portosystemic shunt placement (TIPS) after bleeding was performed more frequently during the pandemic (23.2% vs. 11.3%, p = 0.019). Conclusions: Relevant patient-related AVB outcomes were unaffected during the COVID-19 pandemic. These findings suggest the resilience of critical AVB management practices in German tertiary centers. The increased use of TIPS and MASLD prevalence during the pandemic may reflect evolving clinical practice and patient profiles warranting further investigation. Full article

(This article belongs to the Special Issue Cirrhosis and Its Complications: Prognosis and Clinical Management)

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11 pages, 1176 KB

Open AccessArticle

Clinically Important Decrease in Liver Stiffness Following Treatment for Hepatitis C: Outcome of the TraP HepC Nationwide Elimination Program

by Smári Freyr Kristjánsson, Sigurdur Olafsson, Magnús Gottfredsson, Thorvardur Jon Love and Einar Stefán Björnsson

J. Clin. Med. 2025, 14(11), 3982; https://doi.org/10.3390/jcm14113982 - 5 Jun 2025

Cited by 1 | Viewed by 1604

Abstract

Background/Objectives: Direct-acting antiviral (DAA) therapy has been highly successful in treating chronic hepatitis C (CHC). The nationwide Treatment as Prevention of Hepatitis C (TraP HepC) initiative that was launched in Iceland in 2016 utilized liver stiffness measurements (LSM) to assess liver fibrosis at baseline and follow-up. We aimed to determine changes in liver stiffness among patients following treatment with DAAs and evaluate risk factors associated with hepatic fibrosis. Methods: Eligible CHC patients with liver stiffness of >9.5 kilopascals (kPa) before DAA treatment were invited for a follow-up visit in 2024. Risk factors for cirrhosis were registered, LSM performed, and liver enzymes, blood lipids, and glucose levels measured. Changes in liver stiffness were compared to baseline measurements, and correlations with risk factors were analyzed. Results: A total of 96 patients had LSMs > 9.5 kPa at treatment initiation. During the follow-up period, 61 were eligible for participation, 38 consented, and 34 (35%) died. The total follow-up was 258.3 person-years. The median follow-up period between measurements was 7.1 years. The median liver stiffness decreased from 17.2 kPa to 7.3 kPa (p < 0.01), and 80% of those with cirrhosis (>12.5 kPa) regressed to non-cirrhotic values. High BMI and daily alcohol consumption were significantly associated with increased liver stiffness in 8% of patients. Conclusions: In this single-arm, pre-post pilot study, liver stiffness regressed significantly in 92% of patients who were cured of CHC. Patients with other persistent risk factors following cure, such as obesity and alcohol abuse, were the only patients who had increased liver stiffness at the end of follow-up. Full article

(This article belongs to the Special Issue Cirrhosis and Its Complications: Prognosis and Clinical Management)

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Review

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14 pages, 1025 KB

Open AccessFeature PaperReview

Portopulmonary Hypertension and Hepatopulmonary Syndrome: Contrasting Pathophysiology and Implications for Liver Transplantation

by Vanja Silić, Daniela Bandić Pavlović, Feđa Džubur, Ivan Romić, Igor Petrović, Goran Pavlek, Jurica Zedelj, Gzim Redžepi and Miroslav Samaržija

J. Clin. Med. 2026, 15(1), 72; https://doi.org/10.3390/jcm15010072 - 22 Dec 2025

Viewed by 1459

Abstract

Portopulmonary hypertension (PoPH) and hepatopulmonary syndrome (HPS) present two vascular complications of portal hypertension, which make opposite extremes occur against the same pathophysiological background. In PoPH, vasoconstriction predominates, along with gradual remodeling of pulmonary arteries, while HPS develops due to pathological vasodilation and creation of intrapulmonary shunts. Even though they come about by different mechanisms, both disorders significantly affect quality of life, survival, and the possibility of liver transplant. In the early phases, in clinical practice, symptoms are mainly mild and nonspecific, and overlapping with symptoms of advanced liver disease often delays forming a diagnosis. In PoPH, elevated pressures in pulmonary arteries and increased vascular resistance are observed, while HPS exhibits arterial hypoxemia with normal or lowered pulmonary pressure. Standard diagnostic workup includes echocardiography, right-heart catheterization, and analysis of the arterial gases. In patients with severe PoPH, pronounced pulmonary hypertension can represent absolute contraindication for liver transplantation due to risk of acute right heart failure during operation. Conversely, HPS usually resolves itself after a successful transplant, which confirms that the transplant is an indication of being potentially curative. Therapeutic possibilities for both states are still limited. In PoPH, specific vasodilators and supportive measures are applied, while HPS treatment is mostly supportive, directed at maintaining oxygenation until the transplant. Future research should be focused on the development of targeted therapies that address vascular remodeling, angiogenesis, and oxidative stress, as well as on the standardization of diagnostic criteria and multicentric cooperation. This approach would facilitate earlier recognition, a precise assessment of transplantability, and a better long-term outcome for patients with portal hypertension and lung vascular complications. Key Points: Portopulmonary hypertension (PoPH) and hepatopulmonary syndrome (HPS) represent two opposite vascular complications of portal hypertension, posing distinct challenges for liver transplantation. This review summarizes their pathophysiology, diagnostic pathways, and therapeutic strategies, emphasizing the importance of hemodynamic profiling and multidisciplinary management to optimize transplant outcomes. Full article

(This article belongs to the Special Issue Cirrhosis and Its Complications: Prognosis and Clinical Management)

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